Recovering from a perineal tear

This information is about recovering from a perineal tear at home. Find out more about how perineal tears happen and what is done to treat them. 

How do I look after my stitches when I go home?

Try to keep the area as clean as possible:

• Have a shower or bath every day. You can use the shower head to gently wash the wound area. Do not rub soap into the wound, just the let soap run off your body as usual.
• Wash your perineum after every visit to the toilet. Make sure the wound is completely dry by patting with a clean dry towel.
• Change your maternity pads often to reduce the risk of infection (as you will have some bleeding after birth).  
• Easing any pain or discomfort

To help with any pain:

• Take paracetamol, which can help with any stinging, or ibuprofen, which can help with swelling. Both painkillers are safe to take if you’re breastfeeding but make sure you read the labels carefully. 
• Put an ice/cool pack on the area for about 10 minutes at a time. Wrap this in a flannel or towel to avoid ice-burn, which can be painful. Your midwife may also suggest using a maternity pad that has been kept in the fridge or freezer.
• Take a warm bath. 
• Sit on a rubber ring (for no more than half an hour at a
  time as this can restrict circulation). 
• Change your position regularly. You could try standing up for a bit, then sitting down or lying on your side.
• Use a small jug to pour warm water over your perineum during and after weeing, which can help with the stinging.
• Try to eat a healthy, balanced diet and stay hydrated to avoid painful constipation.  If you are still constipated, see a pharmacist or GP who may be able to give you something to make your stools softer.

Some pharmacies and chemists sell creams or sprays containing local anaesthetic. But these can be expensive and there is no proof that they work. 

Helping the area to heal

To help the area heal:

• Avoid using a hairdryer on the area (even on a cool setting) as this can damage the tissue. The dust and hair particles can also blow off the hairdryer and get stuck in the wound and cause infection. Use a clean towel to pat the area dry instead.
• Wear breathable materials, such as cotton. Disposable briefs with loose clothing can also help.
• Do your pelvic floor exercises. This helps increase the blood flow to the area and speed up the healing process. Doing pelvic floor exercises will also help strengthen the muscles around the vagina and the anus, which should help improve any issues controlling your bowels. 
• Avoid smoking as this can affect how well the wound heals.  
• Avoid heavy lifting or strenuous exercise for 4-6 weeks after childbirth.  

Do not use any cream, lotions or spray that contain steroids because these can slow down the healing process. 

Tell your healthcare professional if you have any concerns

Tell your midwife, health visitor or GP if:

• your stitches become painful
• your stitches become smelly
• your wound does not heal
• you have been diagnosed with a first- or second-degree tear, but you are having problems controlling your bowels, for example if you struggle to make it to the toilet or control wind
• you pass poo through your vagina
• you have a fever (a sign of infection)
• you have any other concerns. 

What happens when I open my bowels?

Your stitches shouldn’t be affected when you do a poo. Try to avoid constipation by eating a healthy, balanced diet and drinking at least 2 litres of water a day.

If you have had a third- or fourth-degree tear, you’ll be given some laxatives (a medicine that helps to loosen your bowel movements) so you don’t need to push too hard when you poo. Sometimes these may work so well that you may not get to the toilet in time. This should improve after a couple of days.

The Royal College of Obstetricians and Gynaecologists also suggest the following to help you open your bowels: 

• put your feet on a footstool to raise your knees above your hips while you sit on the toilet
• take deep breaths to avoid straining
• gently push down from your bottom rather than holding your breath
• take your time and don’t rush
• don’t delay if you need to go to the toilet
• do your pelvic floor exercises.

What is the likelihood of a tear causing complications like incontinence?

A first- or second-degree tear is unlikely to cause incontinence (when you pass poo or wee without meaning to).

A third of women have urinary incontinence (weeing without meaning to) after having a baby, regardless of whether they had a tear or not.  It may help to:

• do your pelvic floor exercises
• stop smoking
• avoid high-impact exercises (such as jogging and aerobics)
• avoid heavy lifting (such as older children or shopping bags)
• treat constipation promptly
• cut down on caffeine 
• avoid alcohol
• drink 6 to 8 glasses of water a day.  

It may also help to try and lose some weight slowly. This is easier said than done after having a baby and there is no rush. Remember that your body needs time to recover.

If you had a more complicated delivery, your recovery time will be longer. There’s no need to start doing high-impact exercises or dieting. Just try to concentrate on eating a healthy, balanced diet, drinking plenty of water and doing light exercise, such as walking, until you are ready to do more).

Faecal incontinence

Anal or faecal incontinence is when you have problems controlling your bowels. Symptoms include a sudden uncontrollable urge to poo, passing wind uncontrollably or leaking poo.

Some women who have a third- or fourth-degree tear have problems with faecal incontinence. For most women, this issue gets better. But this may be an ongoing complication for a small number of women. 

Do not be afraid or embarrassed to talk to a healthcare professional if you are having incontinence. You may need extra care, such as surgery. 

“My son arrived in a bit of a rush as he was becoming distressed and I needed a forceps delivery. The epidural worked really well for my pain relief and the stitches afterwards. At home, I took regular paracetamol and ibuprofen, but after a few days noticed that my stitches were pulling apart and the pain was getting worse. 

“I showed my midwife who referred me back to the hospital, where the doctor advised that I should take a week of antibiotics (to prevent infection) and that healing would take place more slowly. I had to really remind myself to do those pelvic floor exercises every time my son had a feed. After about 2 months, everything healed. Talking to other mums now, I realise a lot of them have had a similar experience.”

Seema

Should I have a follow-up appointment after having a tear?

Many hospitals will offer a check-up if you have had a third- or fourth-degree tear. You may also be seen by a specialist women’s health physiotherapist. 

Your GP surgery should offer you a postnatal check 6 to 8 weeks after your baby’s birth to make sure you are feeling well and are recovering properly.  

They may offer an examination to look at how your stitches are healing or you can ask them to check. 

Your health visitor can also check how you are healing.

Don’t feel you have to wait for this appointment. Call your midwife, health visitor or GP if you have any concerns about your stitches. 

Will I need to go back and have the stitches taken out?

No. Your healthcare professional will use dissolvable stitches. These take about a month to dissolve completely. 

How much can I move if I’ve had stitches?

Everyone is different so it’s important to listen to your body and take things slowly. If you’ve had a more severe tear, it’s best to avoid strain or pressure on the area and avoid high-impact exercise or heavy lifting for around 4-6 weeks.  

It can be difficult to look after a baby when you are recovering from giving birth. Take any opportunity you can to take help from a partner, family and friends so you can concentrate on your healing.

Is it possible for the stiches to break?

It is rare for the stitches to come undone. But if there is an infection or pressure on the stitches from bleeding underneath can cause the stitches to break, leaving an open wound. This is called perineal wound dehiscence or breakdown.

Wound breakdown can cause pain, new bleeding or pus-like discharge. You may also begin to feel unwell. Sometimes women notice some stitch material coming away soon after they have had their baby, or can see for themselves that the wound has opened.

Call your midwife, health visitor or GP if you have any concerns about your stitches.

When can I have sex again?

From a physical point of view, you can start having sex again once your stitches are healed and bleeding has stopped.  But it’s also important to think about whether you are emotionally ready to start having sex again.  

Find out more about sex after pregnancy.

When can I exercise again?

It's usually a good idea to wait until after your 6-week postnatal check before you start any high-impact exercise, such as aerobics or running. If you had a more complicated delivery or a caesarean, your recovery time will be longer. Talk to your midwife, health visitor or GP before starting anything strenuous. 

If you’ve had a third- or fourth-degree tear, it may help to:

• mix resting with gentle walks and activity 
• try to avoid lifting anything heavier than your baby for the first 6 weeks
• let someone else lift the buggy, car seat and any other children you have, where possible
• continue your pelvic floor and other gentle exercises. 

Will I tear again if I have another baby?

Not necessarily. Many women go on to have a straightforward vaginal birth after a severe tear. 

Some women think about having a planned caesarean section next time. You’ll be able to talk about how you feel and what your options at your follow up appointment or early in your next pregnancy. 

I feel traumatised by my birth experience. How do I cope with this?

Tearing during labour, especially if you have a third- or fourth-degree tear, can be very distressing. Your partner (if you have one) may also be traumatised. Find out more about recovering after a traumatic birth. 

Some women who experience any birth trauma may develop post-traumatic stress disorder (PTSD). PTSD is an anxiety disorder caused by very stressful, frightening or distressing events.  This may lead to fear of childbirth in the next pregnancy. 

PTSD can develop immediately after an event or it can happen weeks, months or even years later.

It can be very difficult to come to terms with a traumatic event, but PTSD is treatable.  The important thing is to try and confront your feelings with help from healthcare professionals. 

Find out more about post-traumatic stress disorder. 

More support and information

The Masic Foundation supports mothers who have suffered from an injury during childbirth, known as a third- or fourth-degree tear, that results in incontinence. They also have a free helpline for anyone who wants to talk about their treatment or the treatment of loved ones. Call 0808 164 0833 24 hours a day to leave a message and a trained volunteer will get back to you. 

The Birth Trauma Association (BTA) supports women who suffer birth trauma – a shorthand term for post-traumatic stress disorder (PTSD) after birth.

The Birth Tear Support Facebook group is a support group for women who have suffered from severe tearing or episiotomies